Complete Story

04/24/2015

CMS Announces Round 1 2017 a.k.a. Round 1 Recompete, the Sequel

Guest Article by Mark Higley, VP of Regulatory Affairs, VGM Group

Yes, the second re-compete of the Round One re-compete (get that?) is officially on the CMS books. Perhaps recognizing that if future rounds were to continue in any perpetuity (can you imagine in 2023 the “third recompete of the Round 1 recompete”?)

CMS has ostensibly opted to dub future rounds by the program start year of Round 1 or Round 2. Hence, “Round 1 2017″ is what’s up next for our friends in Charlotte, Miami, Pittsburgh and the rest of the original nine.

And to be clear, there will be no program “Round 3″ or “Round 4″ and so on. “Round 1″ is defined by a nine metro-area geography (now consisting of 13 bid areas; details follow below) and “Round 2″, which is defined by a 91 metro area mapping (now consisting of 117 bidding areas).

On a related note and as most are aware, the remainder of the country (about half, by Medicare FFS beneficiary count) will NOT bid in a future round, but effectively inherit the competitive bid payment amounts from either their regional CBA neighbors, or an average of the entire country’s single payment amounts. Click here for more information.

OK let’s talk about the Round 1 2017 program.

To begin, the Round 1 Recompete contracts expire on December 31, 2016. The new Round 1 2017 contracts will become effective on January 1, 2017 for three years. As you may have read in a previous blog, I commented that the reason for the Round 2 recompete contracts having a two and one-half year duration was to match the two geographic rounds into a 12/31 cycle. The “footprint” of the nine metro areas is basically the same (albeit with a few ZIP code changes). However, and emulating the rationale of the Round 2 recompete, competitive bidding areas are restricted to one state. So, instead of nine CBAs, there are 13 with the same footprint but divided by state boundary.

The remaining CBAs are the same: Cleveland-Elyria, OH. Dallas-Fort Worth-Arlington, TX, Miami-Fort Lauderdale-West Palm Beach, FL, Orlando-Kissimmee-Sanford, FL, Pittsburgh, PA, and Riverside-San Bernardino-Ontario, CA. As in the Round 2 recompete, suppliers interested in the metro area can bid on just one – or all – of the new array of CBAs.

Next: Some product category changes.

No infusion pumps and supplies. Round 1 recompete suppliers saw the inclusion of these products. The NHIA strongly advocated against the inclusion of infusion products in future rounds and was successful in that this round does not include infusion pumps, supplies or drugs.

AND…adds a new category never before included in bidding: Non-invasive Pressure Support Ventilators. However, of the 13 CBAs in this round, the NIV category will only be bid in eight: Charlotte-Concord-Gastonia, NC; Chester, Lancaster & York counties, SC; Dallas-Fort Worth-Arlington, TX; Kansas City-Overland Park-Ottawa, KS; Kansas City, MO; Miami-Fort Lauderdale-West Palm Beach, FL; Orlando-Kissimmee-Sanford, FL; and Riverside-San Bernardino-Ontario, CA. Why the addition and why just eight CBAs? Perhaps due to the recent spike in reimbursements; legislation applicable to the program authorizes the category inclusion. And perhaps these areas had relatively higher utilization than the others…I will investigate further.

In any case, CMS plans to announce a more detailed bidding schedule and registration period this summer. This will include the usual “bidder education program” releases, a (probable) late summer bidder registration period to obtain user IDs and passwords, and sometime in “Fall 2015″ the bidding process will begin.

A list of the ZIP codes included in each CBA, specific items included in each product category, program dates, licensure links, facts sheets and more are available now.

Lastly….yes, VGM will be there. Again. Look for updates via the Legislative Updates, on our blog and on VGM Connect.

Not receiving these? Contact our emily.harken@vgm.com or call 800.642.6065 to get signed up! Once available, we will distribute the bidding impact worksheets and other “tools” we offered for the Round 2 recompete (see more at http://www.vgmncbservices.com/)